Using Data to Promote Equitable Implementation: Decision-Making, Data, and Uncertainty in Complex

Systems

Rohit Ramaswamy & Kirsten Kainz

Summer Institute on Implementation Science

June 2019

UNC-CH School of Social Work

Overview of our time togetheru Introduction and Welcome – 10 minutes

u Planning for equitable implementation: fours questions – 10 minutes

u Small group discussion: Data collection for equitable outcomes – 15 minutes

u Identifying barriers to equitable implementation– the Race Equity Map – 10 minutes

u Small group discussion: Data collection for assessment – 15 minutes

u Developing strategies for equitable implementation – CEJ Principles – 10 minutes

u Small group discussion: Developing an action plan– 15 minutes

u Evaluating results – a multi-pronged approach – 10 minutes

u Large group discussion: What have we learned ? – 10 minutes

*A note about the term equity

https://sites.google.com/view/datacollectionforequity/home

Introduction and Welcome

u Briefly, please state your name, your organization and your role.

u “I am Rohit Ramaswamy, Professor at the GillingsSchool of Global Public Health at UNC”

Defining Equitable Implementation

u Two ways of defining:uPassive: Ensuring that implementation is directed

at achieving outcomes for everyone

uActive: Ensuring that implementation is directed toward improving equity

u Our focus will be on the second definition

Planning for Equitable Information

uFour questions:u How do we define outcomes for equitable implementation?

u How we do we identify factors that affect equitable implementation?

u How do we develop strategies to address these barriers?

u How do we evaluate what we have accomplished ?

Outcomes for Equitable ImplementationOutcome Definition

Acceptability Is my implementation acceptable to everyone, not just those structurally empowered and privileged?

Appropriateness Is my implementation a good fit to the objective of advancing equity?

Adoption Does my implementation encourage changes in behaviors to advance equity?

Costs Does my implementation result in affordable solutions ?

Feasibility Does my implementation facilitate ease of access and use?

Fidelity Does my implementation remain true to the principles of advancing equity and justice?

Reach Does my implementation result in ensuring access to everyone?

Sustainability Does my implementation include system changes that persist over time?

Adapted from: Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., ... & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76.

Making data work for us

Curiosity

Data Collection

Analysis & Learning

Data cannot drive learning

What drives curiosity?

experiencedissonance

hunches

intuition Research Evidence

surpriseTheory

pain

fear

HOPE

requirements

SMALL GROUP DISCUSSION• Select one program/initiative/intervention that a member of your group is

working on.

• Describe the target population of the program/initiative/intervention

• Select three outcomes for equitable implementation that would be the most relevant for your program.

• Discuss how you would measure these outcomes using an equitable implementation lens.

• How would you collect data you need for your measurements?

Identifying Factors: The Race Equity Mapu Used to help community coalitions assess where they are in their

journey to address racism

u Adapted from tools developed by the Annie E. Casey foundation

u Aims:u To help frame, promote, and advance understanding and dialogue among coalition

members around key concepts of racial equity and the race equity journey;

u To serve as a self-assessment by coalition members of the coalition's current position/stage of development on the race equity journey (not the personal nor individual organization);

u To offer direction (and possibly prioritization) in setting aims, goals and planning for advancing race equity within their local coalitions and communities

Collaborative Self Assessment Process

Determinants of Equitable Implementationu Individual characteristics:

u Is the community ready to undertake equitable implementation?

u Are all people able to contribute to this process?

u Community/organizational characteristics:u To what extent do norms reflect the dominant or majority culture?

u Are the norms inclusive of people who might have different ways of approaching or doing things?

u Contextual characteristics:

u How well do our systems and processes support equitable implementation?

u What resources (people, money, community or organizational assets) exist to support equitable implementation?

SMALL GROUP DISCUSSION• Review the three outcomes you selected for equitable implementation of your

program/initiative/intervention.

• Discuss how the individual, community and contextual characteristics might be barriers to achieving outcomes in your specific program/initiative/intervention.

• How would you collect data to identify the most important characteristics affecting you program/initiative/intervention?

• From your current knowledge, what are three factors (across all categories) you need to address to ensure that the implementation of your program/initiative/intervention advances equity?

Taking Action - Principles for Collaborating for Equity & Justice

u Principle 1: Address structural racism

u Explicitly address issues of social and economic injustice and structural racism

u Principle 2: Employ community development

u Ensure residents have equal power in determining the coalition or collaborative's agenda and resource allocation

u Principle 3: Employ community organizing

u Work to build resident leadership and power.

u Principle 4: Focus on structural change

u Change policies and systems

u Principle 5: Build on community-engaged scholarship

u Use research on what works as a starting point

u Principle 6: Build core functions

u Build infrastructure for coordination, communication, facilitation and capacity building.

SMALL GROUP DISCUSSION• Review the three factors you identified as the most critical for your

program/initiative/intervention to advance equity.

• Using the handout provided, map these factors to the CEJ principles that most reflect the most critical priorities for your program/initiative/intervention

• Discuss how these principles can facilitate equitable implementation of your program/initiative/intervention

Evaluating Results – A Multipronged Approach - SCALE Initiativeu 20 month learning and doing collaborative between 24 communities (20

pacesetter and 4 “mentor”)

u 3 interrelated areas of focus

u Accelerate community transformation to achieve a Culture of Health with improved population health, wellbeing and equity

u Create rapid spread between communities through the development of relationships and “an adoption culture”

u Develop systems to support rapid dissemination between communities

u Strong formative evaluation to understand what works in communities

Iterative Learning Based Approach

17

Analyze and Synthesize Data

Discuss Results with Stakeholders

Findings guide improvements in implementation

Findings guide improvements in evaluation

SCALE Evaluation Approach

18

Inquiry

Observation

Reflection

SCALE communities

RWJFRobert Wood Johnson Foundation

SCALE Implementatio

n Team:

SCALE Support System

LARGE GROUP DISCUSSION • What have you learned ? What resonated with you?• What questions do you still have ?

• How will you be able to use what you have learned in your work ?